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How to get insurance to pay for rhinoplasty?

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How to get insurance to pay for rhinoplasty

Rhinoplasty surgery is a complex procedure. It is top ranking as the popular cosmetic surgery of the year and one of the most searched terms on google. A nose job can make a dramatic difference in your facial profile and it has a great functional feature too. The nose is the center of the face and any asymmetry or abnormal contours stand out in a big way and disrupts the entire facial harmony. Unlike other features of the body, a perfect nose does not stand out and often gets unnoticed. But when it distracts from the rest of the features such as eyes or lips it negatively impacts the self-esteem of the individual.

Rhinoplasty or the nose job is surgery done to improve the nose contours, proportions, and functions. This involves manipulating the bone, cartilage, skin, and tissues inside the nose. For example if you are going in for dorsal hum correction then the part of the bone needs to be shaved or filed off to straighten the bones. However, the cost of rhinoplasty can be different for some and many have this question in mind whether their insurance covers rhinoplasty and if yes then how to claim that. How to get the nose job covered by insurance is one of the primary questions that most patients ask during the initial consultation.

To correctly answer the question that if insurance covers nose jobs, it is important to understand the types of rhinoplasties.

There are mainly two types of rhinoplasties.

Cosmetic and Medical or functional. In both nose jobs, aesthetics remain a primary concern. But when it comes to talking about insurance, a cosmetic nose job is NOT covered in insurance whereas functional rhinoplasty can be fully or partially covered by insurance.

How to get a nose job covered by insurance

Functional rhinoplasty is done to repair the inner structure of the nose and create free airflow. This helps the patient breathe normally. Functional defects in the nose can be because of birth defects such as a deviated septum or a narrow nose or because of nasal trauma, injury or accident, etc. A medical nose job might not make any major appearance changes in your nose but it can manipulate the nasal contours in a way that is visibly more pleasing.

In order to get your nose job covered by insurance, you will have to prove that the rhinoplasty surgery addresses the functional problems of the nose and cannot be treated without surgery. You will also show reports that the conservation corrections have not worked. Insurance cover for nose jobs can be admitted for the treatment of

  • Deviated septum i.e., septoplasty. This surgery is part of a rhinoplasty procedure done to correct the crooked bone and cartilage between the two nostrils. This helps in correcting breathing problems and the crooked nose
  • Nasal fractures because of injury, trauma, or accidents that are blocking the airway to the nose and making it difficult to breathe normally
  • Sinus inflammation that is chronic and does not respond to other treatments
  • Polyps
  • Other structural abnormalities.
  • Burn treatment.

The following cosmetic treatments of rhinoplasty are not covered by rhinoplasty insurance

  • Any change in the shape of the nostrils
  • Tip plasty i.e., modification in the shape and size of the tip
  • Narrowing of nasal bridge
  • Straightening a crooked nose
  • Correcting nasal bumps
  • Changing nose angle
  • Liquid rhinoplasty

Most plastic surgeons often do both rhinoplasties in combination i.e., they correct the internal passages along with the exterior shape and contours. Which is actually a double benefit for the patient. However, the insurance will only cover the medical part of the treatment.

So, should I avoid rhinoplasty because of its cost?

Now that we know exactly what part of rhinoplasty insurance covers, the question arises that should we avoid rhinoplasty. The answer is no.  Rhinoplasty has many benefits that are far greater than the cost. Rhinoplasty can help you with

  • Relief from congestion
  • Reduced sense of smell
  • Chronic nasal and sinus inflammation
  • The problem of breathing through the nose
  • Headaches caused because of sinus
  • Regular breathing
  • Turbinate reduction

Do you qualify for functional rhinoplasty?

In order to claim insurance cover for a nose, the plastic surgeon first has to determine if you are a suitable candidate for functional rhinoplasty. If you are suffering from any of the following conditions than a simple or complex rhinoplasty can bring you much needed relief.

  • Congenital nasal defects
  • Collapsed airways
  • Injury to the nose like a broken nose
  • Narrow nose hampering in regular breathing and other functions
  • Nasal trauma from infections and congestions.

Since rhinoplasty surgery is a permanent procedure and changes cannot be reversed but only corrected through a revision rhinoplasty, to be a good candidate you should have

  • Completed facial growth which is ideal by the time you turn 20
  • Sound physical and mental health
  • No smoke or alcohol abuse history
  • Realistic expectations and a good understanding of the surgery

How to get a nose job covered by insurance

Here are steps to follow for insurance claim

  • Talk to health insurance about the coverage that you can get. There are clear guidelines for this. Ask about how much pre and post-operation cost they cover. This is a much safer option than assuming the coverage. Every insurance provider has set criteria and parameters to determine a patient’s medical coverage depending on the plan that they have opted for.
  • Check if the hospital accepts your insurance provider and whether you have opted for a cashless treatment or not
  • All top hospitals have an insurance department that can help you with the paper work
  • Make sure that you take all your documents especially the insurance card with you when you go to the hospital for the day of surgery
  • Before you leave the hospital, check that all the bills are in order with proper invoice number, signs and seals.
  • If you have paid for the treatment then make sure you attach the payment receipt too.

In cases where the insurance does not cover your type of rhinoplasty or you are not able to get the coverage and are concerned about how much the nose job will cost with or without insurance, you can consider the following potential options too

  • Credit card payments: most credit cards offer an EMI option that you can avail of this way the burden on you reduces and you get the freedom to enjoy the rhinoplasty results.
  • The second option is to talk to the medical facility about the payment options. Most top medical facilities offer suitable payment plans for patients seeking rhinoplasty for cosmetic or functional reasons.

About Dr. Debraj Shome

Dr. Debraj Shome- Facial Plastic Surgeon in Mumbai, India

Dr. Debraj Shome – Founder, The Esthetic Clinics, is a top facial plastic surgeon. Dr. Shome is currently a Consultant at the best Mumbai hospitals like Saifee Hospital, Breach Candy Hospital, Nanavati Hospital & Apollo Spectra Hospital in Mumbai, India. He has 40+ research papers in the best international journals, numerous presentations at conferences & many awards such as “Best Plastic Surgeon in Mumbai”, “Best Plastic Surgeon in India”, Best Cosmetic Surgeon in India”, “Best Cosmetic Surgeon in Mumbai”, “Breakthrough Innovator in Facial Plastic Surgery” etc. A celebrity plastic surgeon, Dr. Shome believes plastic, reconstructive & cosmetic face surgery can allow you to lead a more fulfilled life….Read more

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